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Abstract O-37: ASSESSMENT OF “POTENTIAL FOR LUNG RECRUITMENT” AFTER BEDSIDE PEEP TITRATION BY USING FIVE SLICE CT CHEST PROTOCOL IN PEDIATRIC ARDS

Shaikh, F.1; Mohanty, S.1; Rewatkar, N.1; Poddutoor, P.2; Deepak, R.1; Yerra, A.1; Chirla, D.1

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 17
doi: 10.1097/01.pcc.0000537379.84708.ec
Oral Abstracts
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1Rainbow Children’s Hospital- Banjara Hills- Hyderabad, Paediatric Intensive Care Unit, Hyderabad-India, India

2Rainbow Children’s Hospital- Vikrampuri- Hyderabad, Paediatric Intensive Care Unit, Hyderabad-India, India

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Aims & Objectives:

This is the first investigational study in Pediatric ARDS using CT scan to assess “potential for lung recruitment” after bedside PEEP-titration.

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Methods

The one-year study period had 38 children with moderate to severe ARDS as per PALISI definition, of them 18 were excluded due to clinical instability (14 HFOV, 8 with air leaks, multiple inotropes). The study group (n=20) underwent PEEP titration using P-V loop while on Pressure-Control mode. Using same ventilator settings, they were connected to the appropriately calibrated transport ventilator, and were shifted for five dual-slice varying-intervals protocol CT scan. Lung area was calculated with a software and based on Hounsfield Units was divided into non-aerated (+100 to -100), poorly-aeriated (-100 to -500), well-aeriated (-500 to -900) and hyper-inflated (-900 to -1000).

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Results

PEEP titration achieved significant improvement in SpO2/FiO2 ratio (p=0.0001) and optimum lung compliance. After PEEP titration, average “well-aerated area” was more (57.88%) in Indirect ARDS than Direct ARDS (46.01%) but this was not statistically significant (p=0.184). In-spite of optimum bed-side PEEP titration, average “potential for recruitment” area was 52.64% and 42.03% in indirect and direct ARDS respectively. Radiation exposure in the study group by using five-slice protocol was significantly lower when compared with children from same age group who got chest CT scans for other reasons (0.6657 Vs 1.6484 p=0.0001).

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Conclusions

Bed-side PEEP titration achieved significant improvement in oxygenation and optimum lung compliance. However, CT scan revealed 42–52% lung with “potential for recruitment”. Five-slice CT protocol resulted in significantly less radiation exposure.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies